Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. C URRENT O PINION Advances in multiparametric molecular diagnostics technologies for respiratory tract infections Kate Reddington a,b,  , Nina Tuite a,b,  , Thomas Barry a,b , Justin O’Grady c , and Alimuddin Zumla d Purpose of review Respiratory tract infections (RTIs) are caused by a variety of bacterial, viral, fungal, and other pathogens and cause millions of deaths each year. Current standard microbiological culture-based tests are laborious and time consuming. Thus, patients are initially treated empirically, leading to inappropriate use of antibiotics. The purpose of this article is to provide clinicians and scientists with a review of recently available commercial multiparametric molecular diagnostics tests for the detection of RTIs so that they can be considered for use instead of, or in combination with, traditional culture techniques. Recent findings Several technologies have become commercially available for the multiparametric molecular detection of RTIs in the past decade including tests based on PCR–array, PCR–mass spectrometry, and multiplex qPCR technologies. The majority of these tests are for the detection of viruses, but more recently companies have begun to focus on detection of viruses, bacteria, and associated drug resistances in a single product to maximize the information provided to the clinician by a single test. Summary We describe the recent advances in commercial multiparametric molecular diagnostics technologies for the diagnosis of RTIs. Combining the specific and sensitive molecular detection of bacteria, viruses, fungi, and drug resistances is key if molecular methods are to replace traditional culture. The reliability of the molecular drug-resistance markers chosen, the need for the quantitative detection of some organisms, and throughput are also important considerations for new technology developers. Keywords molecular diagnostics, multiparametric, respiratory tract infections INTRODUCTION Respiratory tract infections (RTIs) are among the top four causes of morbidity and mortality in adults and children worldwide [1,2 & ]. RTIs remain difficult to diagnose accurately as a broad range of pathogens and opportunistic microorganisms are involved in their aetiology including bacteria, viruses, and fungi. Microbiological culture remains the gold standard for the diagnosis of RTIs, the limitations of which include long analysis times (>30 h) and labour intensiveness. Currently, patients presenting to hospital with RTIs are treated empirically without an accurate diagnosis of the causative microorgan- ism or its associated drug-resistance profile [2 & ]. Delays in accurate pathogen-specific diagnoses may result in the prescription of inappropriate anti- biotic therapy and poor treatment outcomes; hence, identifying both the microorganism causing the RTI and any associated drug resistances is essential [3]. Standard UK, European, and US guidelines for diag- nosis and management of pneumonia state that there is a clear need for improved diagnostic testing, most likely using molecular methodology rather than culture [4–6]. Hence, there is an urgent need for rapid and accurate molecular diagnostics tests for a Microbiology, School of Natural Sciences, National University of Ireland, Galway, b Molecular Diagnostics Research Group, NCBES, National University of Ireland, Galway, Ireland, c Norwich Medical School, Univer- sity of East Anglia, Norwich and d Department of Infection, Centre for Clinical Microbiology, University College London, London, UK Correspondence to Dr Justin O’Grady, NRP Innovation Centre, Norwich Research Park, Colney Lane, Norwich, NR4 7GJ, United Kingdom. Tel: +44 1603 597 567; e-mail: justin.ogrady@uea.ac.uk  Kate Reddington and Nina Tuite contributed equally to the writing of this work. Curr Opin Pulm Med 2013, 19:298–304 DOI:10.1097/MCP.0b013e32835f1b32 www.co-pulmonarymedicine.com Volume 19  Number 3  May 2013 REVIEW